Its Mental Health System Is “Overwhelming, Complicated, and Messy.” Wake County Wants to Fix That

It's easy to blame people who are dealing with mental illness. But the road to recovery is more often like a series of paths through a forest, sometimes connecting, often not touching, and too frequently leading the person needing help in the wrong direction.

Brian Klausner, an internist at WakeMed, pointed this out at a recent Wake County Behavioral Health Summit, referencing as an example a woman staying beneath a bridge, self-medicating her psychiatric disorder with heroin.

"It's easy, it's lazy, but it's convenient for us to blame the patient," Klausner said. The existing system, he added, is "overwhelming, complicated, and messy."

The meeting, held last Thursday at the Raleigh Convention Center, brought together more than two hundred professionals, government officials, activists, and others. Their goal: to knit into a cohesive whole the array of services to help people in Wake County with mental illness.

As part of that effort, assistant county manager Denise Foreman presented a series of conclusions drawn from studies by SAS, the multibillion-dollar software and data company, and N.C. State.

Handling these cases in a more proactive, cost-effective manner could save significant money, according to outgoing county manager Jim Hartmann and Board of Commissioners chairman Sig Hutchinson. For example, providing supportive housing for a person with mental illness costs far less than caring for him in jail. And it's great to prescribe treatment for someone, but that person needs reliable transportation to make her appointments.

Analyses by SAS and N.C. State of hundreds of people with mental illnesses treated by Wake County have opened up new possibilities for coordinating care and information, ideally resulting in better health results and lower costs.

N.C. State found that 25 percent of people admitted to the county jail have mental health diagnoses, and those inmates tend to stay behind bars longer. In addition, about a third of those inmates have both mental illness and substance abuse issues. They often receive treatment for one or the other, but not both.

The SAS study found that 807 people during an eighteen-month period came in contact with one of the three high-cost systems: jail, EMS, and homeless shelters.

"Analysis of these 807 individuals shows that this group is between 26 and 55 years old (70 percent) and predominantly male (75 percent)," according to information supplied to summit participants. "Black or African-American males are disproportionately represented (46 percent) in this population."

More than fifty-two hundred both spent time in jail and required help from EMS workers.

One of Wake County's approaches, Foreman said, is to reduce interactions of the mentally ill with the criminal justice system. That can involve diverting someone who's been detained to treatment instead of the detention center.

"If they do get convicted, we'd like to reduce the chances of their coming back into the system," she said.

Wake County spends about $27 million annually on behavioral health, mostly for crisis services. District Attorney Lorrin Freeman said records show that most people with behavioral problems who land in jail generally aren't charged with murder, rape, or other violent offenses, but with low-level, nonviolent offenses. Indeed, according to SAS, more than 70 percent of people who encounter jail, EMS, and behavioral health services are booked for misdemeanor charges.

With help coming from different levels of government, nonprofits, and the business community, it's common for a person with mental health problems to get lost in a bureaucratic maze, participants said.

"We want for there to be no wrong door," said Katherine Hobbs Knutson, chief medical officer at Alliance Behavioral Healthcare. "There should be a seamless path to get to the right treatment at the right time."

Wake County pays Alliance to take care of residents with behavioral health problems. The nonprofit's officials say it would cost more than $180 million to treat people who need care at the level prescribed by Medicaid, the federal health program for low-income people and those with disabilities.

Participants hope that these types of studies can continue—and they'd like to broaden their scope. For example, hospitals that play a major role in treatment couldn't submit data because of federal HIPAA regulations.

Jennifer Conner, who works in local government solutions for SAS, said the company worked on the study with the help of Wake County Directors, a broad-based ad hoc group that includes former commissioner Carolina Sullivan, Freeman, Sheriff Donnie Harrison, Raleigh and its police department, many other Wake departments, and representatives of Alliance. UNC REX, Duke, and WakeMed also provided expertise, Conner said.

"The reasons we wanted to have the hospitals in behavioral health is that they are among the stakeholders," Conner said. "We hope we can bring them in, and the data they have, to enrich the findings."